SCHISTOSOMIASIS

ABSTRACT

Schistosomiasis, also known as “bilharzia or snail sickness” is a disease caused by an

infection of parasitic blood flukes (Schistosomia) and it is estimated that more than 230 million of
people worldwide are infected. Most infected individuals are asymptomatic. Infection occurs from
exposure to freshwater into which snails, the intermediate host of the parasite, have shed cercariae
that can penetrate skin. There are five main species of schistosomes that parasitize humans are S.
mansoni, S. japonicum, S. mekongi, S. guineensis in which these four mainly affect the bowel and
liver and S. haematobium causes urogenital tract disease. Clinical features includes infected person
may experience itchy rash called swimmer’s itch and can develop acute schistosomiasis called
Katayama fever which occurs 4 weeks after exposure to the parasite associated with fever, diarrhea
etc. More serious symptoms includes formation of granulomas, blood in the urine intestinal,
abdominal pain diarrhea and blood in the stool, enlargements of the liver and spleen other organs
that can be affected include the genital system lungs and sometimes even the brain chronic infection
especially in children can lead to anemia. Praziquantel is used as an effective treatment once the
worms have grown a bit and take precautions to avoid exposure to contaminated water. This paper
provides an overview of Schistosomiasis, etiology, clinical manifestations, immune response,
treatments, prevention, and control.

Keywords: Schistosomiasis; bilharzia; snail sickness; Katayama fever; cercariae; snails; Schistosoma
mansoni, Schistosoma japonicum; Schistosoma mekongi; Schistosoma guineensis; Schistosoma
haematobium; Praziquantel; swimmer’s itch; urogenital tract disease;

Overview of the Disease

Schistosomiasis (i.e., bilharzia or snail fever) is a parasitic infection caused by trematodes

that reside in the circulatory system. More than 230 million people worldwide suffer from
schistosomiasis, which causes a range of clinical disease from overt clinical manifestations to subtle
hindrance of day-to-day activities. Infected children can have impaired growth and development.
Infection occurs from exposure to freshwater into which snails, the intermediate host of the
parasite, have shed cercariae that can penetrate skin.
The five main species of schistosomes that parasitize humans are Schistosoma mansoni
which is located in Africa, Middle East, Carribean, South America, S. japonicum which is located in
China, Indonesia and the Philippines, S. mekongi which is located in Combodia and Laos, S.
guineensis which is located in Central Africa, and S. haematobium which is located in Africa and
Middle East. Gastrointestinal and hepatic disease is caused by infection with S. mansoni or S.
japonicum, and urogenital tract disease results from S. haematobium infection. Other schistosome
species less commonly infect humans, including S. intercalatum, which is found in Cameroon and the
Democratic Republic of Congo, and S. mekongi, which is found primarily in the Mekong River basin.
Both species cause gastrointestinal disease. Preventive treatment, which should be repeated over a
number of years, will reduce and prevent morbidity. Schistosomiasis transmission has been reported
from 78 countries. However, preventive chemotherapy for schistosomiasis, where people and
communities are targeted for large-scale treatment, is only required in 51 endemic countries with
moderate-to-high transmission.
The Cause of the Disease

Schistosomiasis is a parasitic illness often known as bilharzia or snail sickness caused by

trematodes that live inside the bloodstream. Larger than worldwide, 230 million people have
schistosomiasis, which results in a variety of clinical diseases with both obvious and subtle symptoms
a barrier to daily activity. Children that are infected may have impaired growth and development.
Infection results from contact with freshwater, whereby the parasite's intermediate host, snails,
release skin-penetrating cercariae.

In the body, the larvae develop into adult schistosomes. Adult worms live in the blood
vessels where the females release eggs. Some of the eggs are passed out of the body in the faeces or
urine to continue the parasite’s lifecycle. Others become trapped in body tissues, causing immune
reactions and progressive damage to organs.

Organisms Response to the Disease

Clinical features include acute schistosomiasis wherein the infected person experiences
febrile illness resembling serum sickness can occur 4 to 7 weeks after the initial infection, concurrent
with maturation of female worms and the first egg release (i.e., Katayama fever association with S.
japonicum infections). Common signs and symptoms are suddenonset fever, cough, abdominal pain,
headache, lymphadenopathy, and mild hepatosplenomegaly. Infected person with intestinal
schistosomiasis S. mansoni, S. japonicum, S. intercalatum, and S. mekongi infections can be
asymptomatic, or they can have crampy abdominal pain, diarrhea, bloody stools, or colonic
polyposis. Physical examination commonly reveals an enlarged, nontender liver and an enlarged
spleen. The end-stage disease consists of portal hypertension, ascites, and portosystemic varices
with an absence of jaundice. Esophageal varices can result in severe bleeding and death. S.
haematobium infections can cause microscopic or gross hematuria, dysuria, and urinary frequency,
and characteristic sandy patches in vaginal mucosa or the cervix. End-stage disease can include
genital lesions, obstructive uropathy, and squamous cell carcinoma of the bladder. Even with light
worm burdens, children may have depressed growth and learning ability and anemia. Dermatitis can
occur within 72 hours of exposure to infected water as cercariae penetrate skin. Cercarial dermatitis
(i.e., swimmer’s itch) also is caused by animal (usually avian) schistosomes, occurring in countries
nonendemic for human schistosomiasis and after exposure to seawater and freshwater.

Parasites can passively evade the immune system in a variety of ways like they hide away
from the immune system by invading immune-privileged tissue. When infected with the parasite the
person may experience symptoms caused by the toxins released by the parasites into your
bloodstream. The infected person experience Katayama disease due to an immune reaction to
these parasites. An immune response to parasites, specifically worms, triggers an IgE
(Immunoglobulin E) response. IgE elicits an immune response by binding to Fc receptors on mast
cells, eosinophils, and basophils, causing degranulation and cytokine release. ( Zwickey & Thompson,
2020)

Treatment, Prevention, and Control

For the treatment, Schistosomiasis can usually be treated successfully with a short course of

a medication called praziquantel, which kills the worms. Praziquantel is most effective once the
worms have grown a bit, so treatment may need to be repeated a few weeks after your first dose.
Steroid medication can also be used to help relieve the symptoms of acute schistosomiasis, or
symptoms caused by damage to the brain or nervous system.

For the prevention, there’s no vaccine for schistosomiasis. So, it’s important to be aware of
the risk and take precautions to avoid exposure to contaminated water. You can check whether the
area you’re visiting is known to have a problem with schistosomiasis using Travel Health Pro’s
country information section. If you’re visiting on one of these areas, avoid paddling, swimming and
washing in fresh water. Only swim in the sea or chlorinated swimming pools. Boil or filter water
before drinking as parasites could burrow into your lips or mouth if you drink contaminated water.
Avoid medicines sold locally that are advertised to treat or prevent schistosomiasis. For this are
often either fake, sub-standard, ineffective or not given at the correct dosage. Don’t rely on
assurances from hotels, tourist boards or similar that a particular stretch of water is safe. Quickly
drying yourself with a towel after getting out of the water is not a reliable way of preventing
infection, although it’s a good idea to dry yourself as soon as possible if you’re accidentally exposed
to potentially contaminated water.

Strategies for controlling schistosomiasis include mass chemotherapy, health education,

behavioral modification, improved sewage and sanitation, and control of snails through
environmental engineering or the use of molluscicides. Large-scale control programs using one or
more of these strategies has had various degrees of success in several countries

References

Montgomery, S., & Richards, F. (2021). Blood Trematodes: Schistosomiasis. Retrieved September 15,
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NHS. (n.d.). Schistosomiasis (bilharzia). Retrieved from

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%20usually%20be%20treated,weeks%20after%20your%20first%20dose.

World Health Organization (2021). Schistosomiasis.

http://www.emro.who.int/health-topics/schistosomiasis/introduction.html

World Health Organization. (2022). Schistosomiasis. Retrieved January 08, 2022, from
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Zwickey, H. & Thompson, B. (2020)18 - Immune Function Assessment, (Vol. 1, pp. 157-165)
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